Making Healthy Choices™

Don Hall DrPH, CHES
Founder of Wellsource, Inc.

• B-Vitamins -- Good for Ailing Hearts

• The New DASH Diet for High Blood Pressure

• What is a Healthy Blood Pressure? -- New Standards

• Glycated Hemoglobin -- A New Marker for Heart Risk

• Metabolic Syndrome -- What it Means to Your Health

• Physical Activity and Breast Cancer Risk

• What's New?

• About this Newsletter

Nutrition Information
Weight Management
Food

B-Vitamins -- Good for Ailing Hearts

Good news for those who have had angioplasties to open blocked arteries. If you take B-vitamins after your angioplasty, you can cut your risk of restenosis (the artery plugging back up again).

A 6-month study on post-angioplasty patients demonstrated that a daily dose of folic acid, vitamin B-12, and pyridoxine vitamins cut the risk of the arteries plugging up again in half. The vitamins also lowered the blood levels of homocysteine in the blood; thought to be a major factor in coronary artery disease.

These same vitamins can also be a primary prevention strategy to help prevent coronary artery disease from occurring in the first place. Good sources of folic acid in the diet are split peas, lentils, garbanzos, pinto beans, spinach, asparagus, orange juice, and other fruits and vegetables.

Reference: N Eng J Medicine 2001;345:1593-1600

The New DASH Diet for High Blood Pressure

Some 50 million people in the U.S. have high blood pressure; one out of every 5 adults. If untreated, high blood pressure damages the heart, eyes, kidneys, and brain.

Eating a healthy diet lowered blood pressure levels significantly. It's called the DASH diet and emphasizes:

• Fresh fruits and vegetables (8-9 servings daily)

• Low-fat dairy products

• Whole grain breads/cereals

• Legumes: peas, beans, lentils, soy

• Nuts and seeds

• Limited red meat, if eaten at all

• Limited sweets and soda pop

More recently, researchers repeated this study but also reduced sodium levels in the diet. They found an even greater reduction in blood pressures when sodium intake was cut in half or more. Drops in blood pressure on the DASH diet with low sodium (<2000 mg/day) were similar to trials using medications to lower blood pressure.

Researchers estimated that if everyone in the U.S. followed this healthy eating plan you would see:

• A 35% drop in prevalence of high blood pressure

• A

  12% reduction in coronary heart disease

• A 30% reduction in stroke

Other lifestyle factors that can lower blood pressure even further include:

• Achieving a healthy weight

• Regular, moderate physical activity, 30+ minutes daily

• Avoiding alcohol and tobacco

Reference: New Eng J Medicine 2001;344:3-10

New Blood
Pressure Norms

What is a Healthy Blood Pressure -- New Standards

A recent report from the Framingham Heart Study looked at the blood pressures of 6,859 healthy men and women (no heart disease or high blood pressure) at the start of the study. During the next 12 years they tracked their blood pressure and the development of any major cardiovascular event such as a heart attack, stroke, or congestive heart failure.

Researchers found that those men and women with high normal blood pressures at the start of the study had a significantly higher occurrence of cardiovascular disease than those with blood pressures less than 130/85. To compare disease rates, the people were divided into three groups:

• Optimum blood pressure, less than 120/80

• Normal blood pressure, 120/80 to 129/84

• High normal, 130/85 to 139/89

Researchers found that the rate of cardiovascular events was a continuous gradient, the higher the pressure the higher the risk, throughout the whole range of "normal" blood pressures. Using the "Optimum" blood pressure as a standard, notice how risk increases:

• Women with blood pressures in the "normal" range had a 10% increase, and those in the "high normal" range an 80% increase in cardiovascular events.

• In men it was a 30% and 60% increased risk respectively. These risks are the observed increase in cardiovascular events even after adjusting for age, overweight, cholesterol level, presence of diabetes (or not), and smoking status.

The bottom line. Even if you don't have high blood pressure, if it is in the "high normal" range you still may have an increased risk of a heart attack or stroke of 60% to 80% compared to those with optimal or a near optimal blood pressure of 120/80 or lower. For optimum health and a really "healthy blood pressure" level, keep your blood pressure near 120/80 or below.

Reference: RS Vasan, et al, Impact of High Normal Blood Pressure on the Risk of Cardiovascular Disease, New England Journal of Medicine 345:1291-1297, Nov. 1, 2001.

Glycated hemoglobin level are an indicator of average blood glucose levels over the past three month.

In this study, glycated hemoglobin levels were a better predictor of
mortality than BMI, cholesterol, or blood pressure.

Glycated Hemoglobin -- A New Marker for Heart Risk

Move over cholesterol. There is a new blood test that may be even more predictive of heart disease than cholesterol. It is called glycated hemoglobin or HbA1c.

This new test has been used for years by diabetics to monitor how effectively they have been managing their blood sugar levels. If they do a good job (eat well, exercise, etc.) their glycated hemoglobin levels fall and so does their risk for heart disease and other health problems linked to high blood sugar levels.

Now a new prospective population study of some 4,662 healthy men aged 45+ shows that the HbA1c test (test for glycated hemoglobin) was a strong predictor for heart disease even in people without diabetes. In fact, in this study HbA1c levels were more predictive of cardiovascular disease than was high cholesterol, high blood pressure, or body mass index (BMI is a measure of weight).

Here is what they found. People with HbA1c levels less than 5.0% had the lowest risk of heart disease. Persons above this level, however, had significantly higher risks as shown in the chart below.

As you can see, the risk for cardiovascular disease (heart attacks or strokes) climbs quickly when the HbA1c level is more than 5.0%. This study found that 70% of the men over 45 years of age had elevated HbA1c levels (greater than 5.0%). Do you know what your HbA1c levels are? If not, the next time you visit your doctor you can ask for this test.

Here are the conclusions the researchers came to:

• Glycated hemoglobin levels significantly predict mortality throughout the whole range of values, even below the threshold accepted for the diagnosis of diabetes

• HbA1c was a stronger predictor of mortality from heart disease or from all causes than was cholesterol, BMI, or blood pressure

• An increase of 1% in HbA1c levels increased mortality rates for heart disease by 40% and death from any cause by 30%.

• About 70% of the population aged 45 or older are at increased risk due to elevated HbA1c levels (greater than 5.0%).

• If the HbA1c levels were decreased by just 0.2% in the entire population, it is estimated that it would reduce the total mortality of that population by 10%.

Lifestyle strategies to reduce HbA1c levels include:

• Increasing physical activity. Regular exercise helps lower blood glucose levels and thus HbA1c levels. Other studies show that regular exercise in diabetics dropped HbA1c levels by nearly 1%.

• Reducing excess body fat. Even losing 10 to 15 pounds can reduce blood glucose levels and insulin resistance which seems to be at the heart of this problem.

• Improving eating habits. Start by eating less refined carbohydrates and high glycemic index foods. Then eat more unrefined foods high in dietary fiber such as whole-grains, vegetables, fresh fruits, and legumes. Lastly, choose to eat healthy fats and healthy protein foods.

Reference: British Medical Journal, Jan. 6, 2001; 322:1-6

24% of the adult population in the U.S. meet the criteria for metabolic syndrome putting them at serious risk for heart disease and diabetes.

Metabolic Syndrome -- What It Means to Your Health

Research in preventing heart disease in past years has centered primarily on smoking, high blood pressure, and high blood cholesterol levels. In the latest report from NIH (National Cholesterol Education Program report on heart health, called the ATP3 report) they identify a "new" risk factor called the "metabolic syndrome". This syndrome, or set of abnormalities, is becoming much more prevalent in the U.S. It increases the risk of a heart attack at a rate similar to smoking, which we know is a major cause of heart disease.

The metabolic syndrome is linked to insulin resistance and high abdominal obesity and results in a series of abnormal or unhealthy changes in the metabolism, increasing the risk of heart disease.

How common is this condition? It's prevalence in the U.S. was reported in this months (January 16) issue of JAMA. Scientists analyzed the health data of 8,814 men and women who were randomly selected from throughout the U.S. and found that 23.7% of the adult population exhibit the metabolic syndrome putting them at significantly increased risk for heart disease and diabetes. This is about 1 out of every 4 adults.

The criteria for this new risk is outlined in the new NCEP report. If you have 3 or more of the following conditions, you exhibit the metabolic syndrome:

• Abdominal obesity -- a waist circumference greater than 35 inches for women or 40 inches for men (measure at the level of your navel, stomach relaxed, not held in).

• High blood fats -- fasting triglycerides of 150 mg/dL or higher

• Low HDL levels -- HDL cholesterol less than 40 for men or less than 50 for women.

• Moderately elevated blood pressure -- 130/85 or higher.

• Moderately high blood sugar levels -- fasting glucose of 110 or higher.

These are all common tests. Your doctor can check these factors for you if you don't know what your test values are. Knowing them can help you take preventive action to reduce your risk.

The primary treatment for this condition is referred to in the ATP 3 report as "therapeutic lifestyle change", primarily:

• weight loss

• increased physical activity, 30+ minutes of moderate activity daily

• improved eating habits, particularly eating less
  - high glycemic index foods (primarily refined carbohydrates
  and sweets)

• and instead eating more high fiber foods:
  - fruits, vegetables, and legumes
  - whole-grain breads and cereals
  - healthy fats
  - healthy protein foods

Research is finding that these healthy lifestyle practices may be just as important as not smoking or treating high cholesterol levels for preventing heart disease.

Reference: JAMA Jan. 16, 2002;287:356-359

Physical Activity
Exercise and Health

Physical Activity and Breast Cancer Risk

Breast cancer is a leading cause of cancer in women and is a great concern for many women. The Division of Cancer Prevention in CDC recently conducted a research project looking at physical activity and breast cancer risk. They studied 6,160 healthy women age 50 or older for several years and correlated level of physical activity with the development of breast cancer.

Here is what was found. Women who consistently participate in high levels of recreational physical activity have a 67% decrease in breast cancer compared to those women who consistently have low levels of activity. When they adjusted for excess body weight, the protective effects of exercise were not changed.

This is great news! Do you want to reduce your risk of breast cancer? Then participate regularly in physical activity. Aim for 30 or more minutes daily of moderate activity such as walking, biking, aerobic dance, or other activities you enjoy. This will not only reduce breast cancer risk but will also help you look and feel your best for all of your years.

Reference: Cancer Epidemiol Biomarkers Prev. July 10, 2001;10:805-8

Products
Seminars
Wellsource News

Wellness Seminar
April 4-5, 2002
Orlando, Florida

Health Awareness Series™ Online

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Marketing Wellness Seminar

The Successful Health Management Systems™ Seminar, presented by Wellsource, the leader in population health management applications will be teaching health professionals and others how to develop and market wellness programs, April 4-5, 2002 at the Sheraton Safari Hotel in Orlando, Florida.

The seminar provides professionals in the health care industry with the opportunity to network with peers and share successes and challenges. The learning experience is facilitated with interactive workshops that encourage participation. For program schedule and registration form. Register early to receive discounted registration and hotel rates.

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15431 SE 82nd Dr.
Portland, OR 97015
(503) 656-7446

About Making Healthy Choices

Making Healthy Choices is written by Don Hall, DrPH, CHES president of Wellsource Inc. with contribution from associated health professionals. It is available as a resource to Wellsource clients and other select organizations involved in promoting health.

Content is general health information from evidence based research. Its purpose is not to treat disease but to promote healthy lifestyles. Persons with health problems should consult their physician for specific guidance.

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